Comparison of ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants: An updated meta-analysis

Haerin Paik, Byung Chul Jee
Journal of Obstetrics and Gynaecology Research · 2024 · vol. 50(6) , pp. 1020–1031 · doi:10.1111/jog.15925 · PMID:38504428 · W4393012408
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

A meta-analysis comparing ovarian reserve after endometrioma cystectomy found the suture method and hemostatic sealants preserved ovarian reserve better than bipolar coagulation.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This updated meta-analysis compared post-cystectomy ovarian reserve, measured by serum anti-Müllerian hormone (AMH) values, after ovarian endometrioma cystectomy using bipolar coagulation versus either suture methods or hemostatic sealants across 14 eligible studies (10 randomized trials, 3 prospective, 1 retrospective; total n=1435). Across groups, both bipolar coagulation and suture methods showed lower AMH at 3, 6, and 12 months, but AMH at 12 months and AMH decline at 3 months were greater (less decline) with suture methods than with bipolar coagulation; pregnancy rates were similar between these groups. For bipolar coagulation versus hemostatic sealants, AMH at 3 months was similar, while the hemostatic sealants group had a less steep AMH decline at 3 months. The paper’s main limitation is substantial heterogeneity for some comparisons (e.g., I2=89–95% in the suture-method comparisons) despite inclusion of multiple study designs. This paper is centrally about endometriosis — it specifically synthesizes evidence on ovarian reserve after cystectomy for ovarian endometriomas and compares surgical hemostasis techniques.

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Abstract

AIM: The purpose of the study was to compare the ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants (HSs). METHODS: We performed a meta-analysis of studies in which post-cystectomy serum anti-Müllerian hormone (AMH) values were compared between bipolar coagulation and suture method or between bipolar coagulation and HSs. Through a literature search, we retrieved 14 articles which met inclusion criteria and were eligible for final analysis. The articles included 10 randomized trials, 3 prospective studies, and 1 retrospective study (n = 1435). The primary outcome was post-cystectomy serum AMH values. RESULTS: Both bipolar coagulation and suture methods showed significantly lower post-cystectomy AMH values at 3, 6, and 12 months. However, post-cystectomy serum AMH values at 12 months were significantly higher in the suture method group compared to the bipolar coagulation (weighted mean difference [WMD]: -1.10, 95% confidence interval [CI]: -1.83, -0.38, p = 0.003, I2 = 89, n = 3). The suture method also showed a lower decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: -25.13%, 95% CI: -49.56 to -0.70, p = 0.04, I2 = 95%, n = 2). Overall, pregnancy rates were similar between the two groups. Between the bipolar coagulation and HSs group, serum AMH values at 3 months post-cystectomy were similar (WMD: -0.46, 95% CI: -1.04 to 0.13, p = 0.13, I2 = 0%, n = 3). However, the HSs group showed a less decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: -17.02%, 95% CI: -22.81, -11.23, p < 0.00001, I2 = 0%, n = 3). CONCLUSIONS: Both the suture method and HSs may have potential benefits in the preservation of ovarian reserve over the bipolar coagulation method when cystectomy for ovarian endometrioma is performed.
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Abstract

Aim The purpose of the study was to compare the ovarian reserve after cystectomy of ovarian endometrioma by bipolar coagulation, suture method, or hemostatic sealants (HSs).

Methods

We performed a meta-analysis of studies in which post-cystectomy serum anti-Müllerian hormone (AMH) values were compared between bipolar coagulation and suture method or between bipolar coagulation and HSs. Through a literature search, we retrieved 14 articles which met inclusion criteria and were eligible for final analysis. The articles included 10 randomized trials, 3 prospective studies, and 1 retrospective study (n = 1435). The primary outcome was post-cystectomy serum AMH values.

Results

Both bipolar coagulation and suture methods showed significantly lower post-cystectomy AMH values at 3, 6, and 12 months. However, post-cystectomy serum AMH values at 12 months were significantly higher in the suture method group compared to the bipolar coagulation (weighted mean difference [WMD]: −1.10, 95% confidence interval [CI]: −1.83, −0.38, p = 0.003, I2 = 89, n = 3). The suture method also showed a lower decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: −25.13%, 95% CI: −49.56 to −0.70, p = 0.04, I2 = 95%, n = 2). Overall, pregnancy rates were similar between the two groups. Between the bipolar coagulation and HSs group, serum AMH values at 3 months post-cystectomy were similar (WMD: −0.46, 95% CI: −1.04 to 0.13, p = 0.13, I2 = 0%, n = 3). However, the HSs group showed a less decline rate at 3 months post-cystectomy compared to the bipolar coagulation group (WMD: −17.02%, 95% CI: −22.81, −11.23, p < 0.00001, I2 = 0%, n = 3).

Conclusions

Both the suture method and HSs may have potential benefits in the preservation of ovarian reserve over the bipolar coagulation method when cystectomy for ovarian endometrioma is performed. CONFLICT OF INTEREST STATEMENT None. DATA AVAILABILITY STATEMENT Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Anti-Mullerian Hormone Anti-Mullerian Hormone Anti-Mullerian Hormone Anti-Mullerian Hormone Anti-Mullerian Hormone Anti-Mullerian Hormone Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Ovarian Reserve Ovarian Reserve Ovarian Reserve Ovarian Reserve Ovarian Reserve Electrocoagulation Electrocoagulation Electrocoagulation

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